methodological issues in mixed methods data: the use of qualitative and quantitative data in health...
TRANSCRIPT
![Page 1: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/1.jpg)
Methodological Issues in Mixed Methods Data:
The Use of Qualitative and Quantitative Data in Health
Services Research.Susan Zickmund, PhD
Director, Qualitative Research CoreCHERP, VA Pittsburgh
Division of General Internal MedicineUniversity of [email protected]
![Page 2: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/2.jpg)
Goal for the Cyber Seminar
Briefly describe the ABCs of qualitative research. Provide an introductory guide to mixed methods designs. Suggest practical ideas on how to best transform qualitative themes into numerical information and then to integrate that into a final analysis plan.
![Page 3: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/3.jpg)
Organization of the Seminar
•Traditional qualitative: description, data types, methods, sample size, recruitment, coding.•Mixed methods: traditional designs, an “Integrated Mixed Methods” approach (with methods, sample size, recruitment, coding), and conclude with examples of integrated mixed statistical models.
![Page 4: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/4.jpg)
Traditional Qualitative Approach
![Page 5: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/5.jpg)
• The focus is on the participants’ subjective viewpoints.
• Words/images are the primary data elements.
• The approach is inductive.• Theory development may be a main
outcome of the analysis.
Description of Qualitative
![Page 6: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/6.jpg)
Central Characteristics
• Having an iterative /open ended approach to the data.• Observations or coding schemes emerge directly from the text.• The researcher strives to avoid bias when interpreting the data.
![Page 7: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/7.jpg)
Classic Components
• Types of data, qualitative methods, determining sample size, recruitment, and coding philosophies.
![Page 8: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/8.jpg)
Data Types
• Interviews/Focus Groups.
• Observational.
![Page 9: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/9.jpg)
Interviews /Focus Groups
Interviews: Allow in-depth discussion with one participant; effective for sensitive topics; interviewer controls the discussion.Focus Group: Allows participants to interact; group dynamics provide unique insight; moderator has less control over discussion with one participant.
![Page 10: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/10.jpg)
ObservationalObservational
• A complex situation where a researcher would need to observe what is occurring in order to best understand the situation.
• Example: Hand washing study.
• Participants may have reasons for dishonesty.
• The activity is open and observable.
![Page 11: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/11.jpg)
Qualitative Methodologies
• Important to have one to guide data collection and analysis.
• Types include:
• Grounded Theory.
• Ethnography.
![Page 12: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/12.jpg)
Grounded Theory• Most prominent method in medicine.
• Uses constant comparisons between cases.
• Can change recruitment goals based on previous findings.
• The goal is an emerging theory.
![Page 13: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/13.jpg)
EthnographyMethod of anthropologists.
• Involves field notes; goal to observe and understand a culture. • Effective for an unique or unknown cultural dimension of medicine.
• Requires a research question best fitted for this method.
![Page 14: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/14.jpg)
Sample Size• Uses “thematic saturation” – idea that once no new themes arise, data collection is complete.
• Minimum sample size for saturation is around 15-20.
• Maximum sample size is any size interfering with “case oriented thrust” of qualitative research (60-100).
![Page 15: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/15.jpg)
Recruitment: Purposeful Sampling
• The goal of recruitment is to purposefully section special cases.• It does not seek “generalizability.”• Types of sampling used include:• Extreme / maximum variation. • Snowball sampling.
![Page 16: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/16.jpg)
Coding Philosophies
• Single investigator.
• Research team approach.
• Independent coders.
![Page 17: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/17.jpg)
Mixed Methods Approach
![Page 18: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/18.jpg)
Mixed Methods Terminology
Multiple types of qualitative data or using experts with different academic backgrounds (“triangulation”). Newer: Integrating qualitative and quantitative data collection together.
![Page 19: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/19.jpg)
The Qualitative-Quantitative Divide
To some, qualitative is seen as incommensurate with empirical data.
Thus, there is a need to conduct the qualitative study in a mixed methods design so as to best overcome this divide.
![Page 20: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/20.jpg)
Time and emphasis (in CAPS).
qual QUANT
qual preliminary
quant QUAL
quant preliminary
QUANT qual
qual follow-up
QUAL quant
quant follow-up
Mixed Methods Designs
![Page 21: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/21.jpg)
qual QUANT
qual preliminary
quant QUAL
quant preliminary
QUANT qual
qual follow-up
QUAL quant
quant follow-up
Mixed Methods DesignsA smaller qualitative study designed to provide data for a larger quantitative one (often survey based).
![Page 22: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/22.jpg)
qual QUANT
qual preliminary
quant QUAL
quant preliminary
QUANT qual
qual follow-up
QUAL quant
quant follow-up
Mixed Methods DesignsA small quantitative study that is the set- up for the major qualitative study to follow.
![Page 23: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/23.jpg)
qual QUANT
qual preliminary
quant QUAL
quant preliminary
QUANT qual
qual follow-up
QUAL quant
quant follow-up
Mixed Methods DesignsA major quantitative study that uses qualitative data to gain insight into its findings.
![Page 24: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/24.jpg)
qual QUANT
qual preliminary
quant QUAL
quant preliminary
QUANT qual
qual follow-up
QUAL quant
quant follow-up
Mixed Methods DesignsA major qualitative study that uses a follow-up quantitative study at the end.
![Page 25: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/25.jpg)
Rarely Integrated at Analytic Level
These studies are sequential. Participants infrequently complete all portions of the data. These cases do not lend themselves readily to analytic integration.
![Page 26: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/26.jpg)
qual QUANT
qual preliminary
quant QUAL
quant preliminary
QUANT qual
qual follow-up
QUAL QUANT
performed @ same time
Simultaneous Design
Where qualitative and quantitative methods reinforce simultaneously.
![Page 27: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/27.jpg)
Simultaneous: Gold Standard
Quantitative (demographics, surveys, clinical) and qualitative data is collected from all participants.Analysis plan integrates the quantitative / qualitative data together. Few examples, but is the best method for fully interpreting data in an empirical study.
![Page 28: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/28.jpg)
Integrating Mixed Methods (IMM):
Overview
Provide practical approach to: Research design. Analytic strategies that best
facilitate integrating qualitative
data into empirical studies.
![Page 29: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/29.jpg)
Data Type, Qualitative Methodology
• The data type used would be dictated by the research question and may not differ.
• One qualitative method that lends itself well is the quasi-statistical method by Crabtree and Miller*, a methodological approach developed for health research.
Doing Qualitative Research, 1992.
![Page 30: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/30.jpg)
Sample Size and Recruitment
Sample size, rather than using “thematic saturation,” would be determined by sample size calculation.Recruitment, rather than using “purposeful sampling,” would be consistent with clinical research, using inclusion/exclusion criteria.Goal is generalizability.
![Page 31: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/31.jpg)
Codebook Construction
Use well-defined methods:Inclusion/exclusion criteria for codes.Sample ~20%-100% of cases for the codebook construction.Audit trail, time/date stamping.Goal is transparency of method.
![Page 32: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/32.jpg)
Coding Philosophy
Independent coders (two). Agreement model to adjudicate differences (need final master file). Inter-coder kappa statistic to measure reliability. Goal is reliability.
![Page 33: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/33.jpg)
Interpreting Kappa Statistics
0.00 = poor 0.01-0.20 = slight 0.21-0.40 = fair 0.41-0.61 = moderate 0.61-0.80 = substantial 0.81-1.00 = almost perfect Rule of thumb: shoot for 0.70 and above
![Page 34: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/34.jpg)
Data Transformation
Convert thematic analysis into present / absent (0, 1).Convert thematic analysis into Likert scales.
![Page 35: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/35.jpg)
Computer Data Management
Software programs (Atlas.ti, Nudist) allow for computerized management of: Interview/focus group files. Codebooks. Codes.
Enables a level of textual complexity not possible with notes alone.
![Page 36: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/36.jpg)
Computer Data Management
![Page 37: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/37.jpg)
Computerized Data Output
Atlas includes the ability to output data to tables and spreadsheets (Excel, SPSS).Atlas uses 0/1 for presence and absence of codes (Likert scales require adaptation).
![Page 38: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/38.jpg)
Computerized Data Output
Useful for master files for integration with other data, and facilitates intercoder reliability files.
MST VIEW BETTER WORSENO CHANGE
SEC VIEW BETTER WORSE
NO CHANGE
1 C436 0 0 0 1 C436 0 0 0
2 C470 1 0 0 2 C470 0 1 0
3 C107 0 1 1 3 C107 0 1 1
4 C69 1 0 0 4 C69 0 0 1
5 C1 0 1 1 5 C1 0 1 1
6 C477 0 0 0 6 C477 0 0 0
![Page 39: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/39.jpg)
IMM Summary *Simultaneous mixed methods, where the data is collected from all participants. *Sample size calculation over “saturation.” *Recruitment: generalizability over “purposive sampling.” Transparency of codebook/coding methods. Intercoder reliability kappa statistics. Computerized management spreadsheets.
![Page 40: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/40.jpg)
Examples of Using Qualitative Data in Statistical Models
Qualitative data as a predictor variable.
Qualitative data as an outcome variable.
![Page 41: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/41.jpg)
IMM: Simultaneous mixed methods design: 1 hour semi-structured interview, survey data, demographics, clinical data.
![Page 42: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/42.jpg)
Qualitative Interview
“View of Self” Code: “As you go through this experience,
have you begun to think about yourself differently?”
Prompts used to guide beyond yes/no.
![Page 43: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/43.jpg)
Additional Quantitative Data
Mortality data (current). Charleston Comorbidity data. Cancer Staging (time of interview). Demographics (self report). Sickness Impact Profile (sub-scales). Hospital Anxiety Depression Scale
(Anxiety/Depression scores).
![Page 44: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/44.jpg)
Distribution of Answers
Data available on 825 participants for “View of Self” code: Better View 22.5% Unchanged View 49.8% Worse View 27.6%
![Page 45: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/45.jpg)
Example of Better View of Self:
“I'm back to realizing that I do have an internal strength; that it will take me wherever I need to go in this journey. And it will be a good journey, whatever the end outcome is.”
![Page 46: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/46.jpg)
Example of Worse View of Self:
“I am not the person that I was (cries). Just to grasp the concept that at a young age you're disabled, just like overnight, is very hard to swallow. That's a very hard thing to tell someone: `Too bad, your life is ruined, you just better learn to go on.’ And at 37, you're thinking: `Oh my gosh, I just had a baby.’ ”
![Page 47: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/47.jpg)
Univariate Results for Predictors of Mortality
“View of Self” <0.001Age <0.001Employed 0.001> High School education 0.007Cancer staging <0.001Sickness Impact Profile
Ambulation 0.017Appetite 0.004Physical Sub-scales 0.011
![Page 48: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/48.jpg)
Final Multivariable Model for Predictors of Mortality
Variables p-value
View of self 0.080
Age <0.001
Cancer Stage <0.001
SIP-Appetite 0.005
SIP-Ambulation 0.008
![Page 49: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/49.jpg)
Racial Disparities QI Project
Racial Disparities in Satisfaction with VA CareZickmund SL, Burkitt KH, Rodriguez KL, Switzer GE, Stone RA, Shea JA, Gao S, Bayliss N, Meiksin R, McClenney LM, Powell CT, Newsome ES, Allen R, Fine
MJ. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System and Philadelphia VA Medical Center; VA Center for Minority Veterans (CMV); VHA Office of the Assistant Deputy Undersecretary for Health
![Page 50: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/50.jpg)
Background
The 2008 VHA Hospital Report Card revealed racial disparities in veteran satisfaction with VA health care.
CHERP and the Center for Minority Veterans were commissioned to identify reasons for the disparity between African Americans and whites.
![Page 51: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/51.jpg)
Objectives
To determine whether racial differences in satisfaction existed in overall, outpatient, and inpatient VA care.
To describe racial differences in satisfaction in eight domains of health care quality.
![Page 52: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/52.jpg)
Design
Multi-site QI of 30 white/30 African American veterans (20 per site).
Telephone interviews with Likert scale and open-ended questions.
Demographic data collected.
![Page 53: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/53.jpg)
Qualitative Methods• Interviews were coded by 2 coders using an iteratively developed codebook.
• Intercoder reliability statistic was Kappa=0.99.
• Coded themes were then aggregated within the 8 health care domains, with a distinction between “satisfied” and “dissatisfied.”
![Page 54: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/54.jpg)
8 Health Care Quality Domains Trust in provider Pain management Feelings of respect Access to medical care Communication with providers Coordination of care Involvement of family and friends. Role of race
![Page 55: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/55.jpg)
Domain: Access to Care
“One of the things [that’s] a concern for me individually right now is that I’m trying to get a primary care doctor now, and that’s like, well…I haven’t had one, and I’ve been attending the VA off and on for six, seven years.”
![Page 56: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/56.jpg)
Domain: Role of Race
Veteran: “A lot of times, they, especially people of color and black, Hispanics, Latino, et cetera like that, they [the providers] have a tendency to act like we’re lying, or you want to get high, or you’re trying—you know, it’s almost—you’ve got to either act out or cry or some kind of way to validate…”
Q: “That you’re really in pain.”
Veteran: “Yes, yes.”
![Page 57: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/57.jpg)
Statistical Analysis of Qualitative Data
• 1. Using Chi Square statistics on codes.
![Page 58: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/58.jpg)
Total(N=60)
African American
(N=30)
White(N=30) p-
value
n % n %
Domain 1: Trust in Medical Providers
Dissatisfied
Primary care provider 20 12 40.0 8 26.7 0.40
Provider(s) not giving enough information
1811 36.7 7 23.3 0.40
![Page 59: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/59.jpg)
Statistical Analysis of Qualitative Data
• Using statistical modeling.• Item response theory approach (the Rasch model).• Fit random intercept logistic models were used to assess the differences between African American and white veterans accounting for domain and dissatisfaction/satisfaction themes.
![Page 60: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/60.jpg)
Themes of Satisfaction and Dissatisfaction by Domain
Odds Ratiofor African Americans(95% CI )
P-value
Trust in Medical Providers
Dissatisfied 1.40 (0.63, 3.09)
0.41
Satisfied 0.36 (0.18, 0.73)
0.005
![Page 61: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/61.jpg)
Conclusion • Mixed methods allow the richness of qualitative themes to be used along with quantitative data.
• Sequential designs facilitate combining qualitative and quantitative work, but do so in a segmented way.
• IMM approach enables the integration of the qualitative data at the level of the statistical analysis.
![Page 62: Methodological Issues in Mixed Methods Data: The Use of Qualitative and Quantitative Data in Health Services Research. Susan Zickmund, PhD Director, Qualitative](https://reader035.vdocuments.us/reader035/viewer/2022062404/551aa1d1550346e0158b5957/html5/thumbnails/62.jpg)
Questions?Susan Zickmund, PhD
Director, Qualitative Research CoreCHERP, VA [email protected]
412-954-5259